MEDICARE: KURENAI HAMADA LMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	Y8679798	CA
2	225700000X	Massage Therapist	74879	CA

General Provider Information

NPI Number	:	1285244467
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KURENAI HAMADA LMT

Provider Business Mailing Address
First Line	:	2340 SEPULVEDA BLVD STE A
Second Line	:
City	:	TORRANCE
State	:	CA
Zip	:	90501-4331
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2340 SEPULVEDA BLVD STE A
Second Line	:
City	:	TORRANCE
State	:	CA
Zip	:	90501-4331
Country	:	US
Telephone Number	:	310-539-6633
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/03/2020
Last Update Date	:	08/03/2020

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